Provider Toolkit

• Medicare Plus Blue PPO Manual — Updated April 2021 (PDF)
  
• Medicare Advantage PPO provider agreement and contract amendments

Billing and payment

• Eligibility and coverage
• Billing members
• Submitting claims
• Overpayment
• Reimbursement
• Claims questions and appeals
• If you don't participate with Medicare
• Covered Laboratory Services for MPSERS Members (PDF)

Care management

• Preauthorization and utilization management
• Care management
  

Coverage details

• Medicare Plus Blue PPO benefit summary
• Enhanced benefits
• DME/P&O, medical suppliers and pharmacists
• Medicare Advantage PPO lab network
• Specialty care for Medicare Plus Blue PPO
• Prescription drugs, drug plans and vaccines
• Medicare Advantage PPO medical drug policies and forms
• Medicare Diabetes Prevention Program

Evaluation and management

• Hospice care
• Advantasure® Remote CDI Program™ (PDF)
  • Clinical Documentation Improvement Alert sample (PDF)

General Medicare resources

• Acronym list
• CMS Quality Star Ratings program
• CMS Quality Star Ratings: Star measure tip sheets
• CMS resources
• Medicare guidelines
• Types of products
  

BCBSM Medicare Advantage provider resources

• Contact information
• FAQs
• Fraud, Waste, Abuse and Compliance training
• Health e-Blue

BCBSM Medicare Advantage member resources

• Advance directive
• Medicare Advantage member website
• SilverSneakers™ fitness program
• Medication therapy management
  
• BCBSM Medicare Advantage member extras